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鼻胃管灌洗对急性胃肠道出血治疗效果的影响

发布日期:2014-1-29 12:40:21 文章来源:GIE 作者次数:1172
    鼻胃管灌洗对急性胃肠道出血治疗效果的影响
     
    背景
    鼻胃管灌洗常用于治疗早期胃肠道出血患者。实施这手术的前提是假定鼻胃管灌洗能够及时有助于风险分层和管理。
     
    目的
    进行一项回顾性分析,以测试鼻胃管灌洗是否与胃肠道出血改良处理措施和结果有关。
     
    设计
    倾向性匹配回顾分析
     
    环境
    大学为基础的退伍军人事务医疗中心
     
    患者
    共收治632例胃肠道出血患者
     
    主要测量结果
    30天的死亡率,住院天数,输血要求,手术,内镜检查时间
     
    结果
    接受鼻胃管灌洗的患者更有可能服用非甾体类消炎药并被送往重症监护,但他们不太可能患转移性疾病或心动过速,需服用华法林或在平日出现的几率较小。 倾向性匹配后,鼻胃管灌洗并不影响患者死亡率(比值比[OR] 0.84; 95%可信区间[CI]为0.37-1.92),住院天数(7.3比8.1天,P = 0.57),手术(比值比1.51; 95%可信区间为0.42-5.43),或输血(3.2比3.0个单位,P = 0.94)。 然而,鼻胃管灌洗与早期内镜检查(比值比1.49; 95%,可信区间为1.09-2.04)相关,抽吸出血与高风险性病变有关(比值比 2.69; 95%,可信区间为1.08-6.73)。
     
    局限性
    回顾性设计
     
    结论
    实施鼻胃管灌洗与内镜早期表现有关,但这并不影响临床结果。在开始分流时实施鼻胃管灌洗可以更及时促进其护理过程, 但仍需进一步研究来证实这些发现。
     
    缩写词:NGL为鼻胃管灌洗,NSAIDs为非甾体抗炎药, NVUGIH为非静脉曲张性上消化道出血,OR 比值比
     
     

    Impact of nasogastric lavage on outcomes in acute GI bleeding

    Background
    Nasogastric lavage (NGL) is often performed early in the management of GI bleeding. This practice assumes that NGL results can assist with timely risk stratification and management.
    Objective
    We performed a retrospective analysis to test whether NGL is associated with improved process measures and outcomes in GI bleeding.
    Design
    Propensity-matched retrospective analysis.
    Setting
    University-based Veterans Affairs medical center.
    Patients
    A total of 632 patients admitted with GI bleeding.
    Main Outcome Measurements
    Thirty-day mortality rate, length of hospital stay, transfusion requirements, surgery, and time to endoscopy.
    Results
    Patients receiving NGL were more likely to take nonsteroidal anti-inflammatory drugs and be admitted to intensive care, but less likely to have metastatic disease or tachycardia, be taking warfarin, or present on weekdays. After propensity matching, NGL did not affect mortality (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.37-1.92), length of hospital stay (7.3 vs 8.1 days, P = .57), surgery (OR 1.51; 95% CI, 0.42-5.43), or transfusions (3.2 vs 3.0 units, P = .94). However, NGL was associated with earlier time to endoscopy (hazard ratio 1.49; 95% CI, 1.09-2.04), and bloody aspirates were associated high-risk lesions (OR 2.69; 95% CI, 1.08-6.73).
    Limitations
    Retrospective design.
    Conclusions
    Performing NGL is associated with the earlier performance of endoscopy, but does not affect clinical outcomes. Performing NGL at initial triage may promote more timely process of care, but further studies will be needed to confirm these findings.
    (作者:)
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